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Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital

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  • Alan M. Garber
  • Victor R. Fuchs
  • James F. Silverman

Abstract

In order to gain insight into the possible consequences of prospective payment for university hospitals, we studied 2,025 admissions to the faculty and community services of a university hospital, measuring differences in case mix, costs, and outcomes. The faculty service case mix was disproportionately weighted toward the more costly diagnoses, but even after adjustment for diagnosis-related groups (DRGs), costs were 11 percent higher on the faculty service. The differential was proportionately greater for diagnostic costs than for routine or treatment costs, and the differential was particularly large (70 percent) for patients with a predicted probability of death (DTHRISK) of .25 or greater.The in-hospital mortality rate was appreciably lower on the faculty service after adjustment for case mix and patient characteristics. The mortality differential between the two services was particularly large for patients in the high death risk category. Comparison of a matched sample of 51 pairs of admissions from the high death risk category confirmed the above results with respect to costs and in-hospital mortality, but follow-up revealed that the mortality rates were equal for the two services at nine months after discharge.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 1159.

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Date of creation: Jun 1983
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Publication status: published as Garber, Alan M., Victor R. Fuchs and James F. Silverman. "Aase Mix, Costs , and Outcomes: Differences Between Faculty and Community Services in a University Hospital." The New England Journal of Medicine, Vol. 310, No. 19 (May 10, 1984), pp. 1231-1237
Handle: RePEc:nbr:nberwo:1159

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  1. Sloan, Frank A. & Feldman, Roger D. & Steinwald, A. Bruce, 1983. "Effects of teaching on hospital costs," Journal of Health Economics, Elsevier, vol. 2(1), pages 1-28, March.
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Cited by:
  1. Frank A. Sloan & Gabriel A. Picone & Donald H. Taylor, Jr. & Shin-Yi Chou, 1998. "Hospital Ownership and Cost and Quality of Care: Is There a Dime's Worth of Difference?," NBER Working Papers 6706, National Bureau of Economic Research, Inc.
  2. Cutler, D.M., 1992. "The Incidence of Adverse Medical Outcome Under Prospective Payment," Harvard Institute of Economic Research Working Papers 1603, Harvard - Institute of Economic Research.
  3. Victor R. Fuchs, 1984. ""Though Much is Taken" -- Reflections on Aging, Health, and Medical Care," NBER Working Papers 1269, National Bureau of Economic Research, Inc.

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